Provider Demographics
NPI:1831149046
Name:SULENTICH, KATHLEEN (MD/FACOG)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:SULENTICH
Suffix:
Gender:F
Credentials:MD/FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 13TH AVE E
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-3675
Mailing Address - Country:US
Mailing Address - Phone:218-263-7540
Mailing Address - Fax:866-732-0699
Practice Address - Street 1:307 1ST ST S
Practice Address - Street 2:SUITE 112
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2696
Practice Address - Country:US
Practice Address - Phone:218-741-6221
Practice Address - Fax:218-741-2550
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19781174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN29304SUOtherBCBS